Surgical suture



April 23, 1964 w. H. PEARSON ETAL 3,130,728

SURGICAL SUTURE Filed Sept. 6. 1962 INVENTORS. fil/AM 14 21916450/454,004 5206A United States Patent 3,130,723 SURGICAL SUTURE WilliamH. Pearson, Portland, Greg, and Edward A. Block, North Plainfield, Ni,assignors to Ethicon, lino, Somerville, NJ, a corporation of New JerseyFiled Sept. 6, 1962, Ser. No. 221,827

5 Claims. (Cl. 128-3355) This invention relates to an improved surgicalsuture for use in cataract surgery and more particularly to a surgicalsuture comprising a length of silk suture attached to a length ofcatgut.

Heretofore, either silk sutures or catgut sutures have been used incataract surgery. Silk sutures have been found to have a disadvantage inthat frequently downgrowth of epithelium along the suture tract occursand there is an increase in polymorphonuclear infiltration fromrelatively slight infiltration in the beginning until, at the end of thethird week, the silk suture is usually surrounded by an area of necrosisand a consistent decrease in fibroblastic proliferation in the vicinityof the suture. When silk sutures are used in cataract operations, it isnecessary to remove the silk after healing has taken place, and it hasbeen found that in nervous and uncooperative patients loss of theanterior chamber, anterior chamber hemorrhages, and iris prolapse arecommon complications. Because of the above disadvantages inherent in theuse of silk sutures in cataract surgery, the use of surgical gut haslargely replaced the use of silk sutures. A number of surgeons haverecommended the use of moderately chromicized surgical gut which has theadvantages that there is no hazard of necrosis occuring around thecatgut suture and fibroblastic repair continues unhindered. In addition,because catgut is absorbable in tissue, it is unnecessary to removecatgut sutures after healing, and thus all hazards connected with theremoval of silk sutures are eliminated.

Frederick W. Stocker, M.D., in an article published in American Journalof Opthalmology, vol. 42, No. 5, November 1956, entitled The Use ofcorneoscleral Gut Sutures described a surgical procedure in which catgutsutures were used in cataract surgery. In the procedure of the article,which has been widely accepted by members of the surgical profession,the usual preparation and anaesthesia are followed and a conjunctivalflap is dissected from above. A nonperforating incision is made in thesclera to provide a groove. Moderately chromicized absorbable catgutsutures are passed through the anterior and posterior lips of thegrooves at two places. A loop is formed by pulling each of the suturesout of the groove. Sectioning of the sclera is completed while care istaken that the sutures are not cut. After the cataract extraction iscompleted in the usual way, the two corneoscleral sutures are tied in atriple knot. The conjunctival flap is pulled back so that it covers thesutures completely and is sutured into place by superficial sutures,preferably of unchromicized catgut. The procedure is reported to re sultin perfect closure and approximation of the wound. The postoperativecourse is usually very smooth; the external conjunctival sutures becomepartly absorbed and the remnants slough out within a few days,especially if plain unchromicized gut has been used. There is noirritating or scratching sensation from the corneoscleral sutures sincethey are covered by a conjunctival flap.

One prominent disadvantage of the use of a catgut suture incorneoscleral suturing according to the abovedescribed procedure is thata catgut suture is difficult to handle during the operation due to itslack of pliability and its tendency to twist upon itself. Thisdisadvantage is most apparent when a loop is formed in the suture beforesectioning of the sclera is completed. Because of the lack of pliabilityand the tendency of a catgut suture to twist on itself, somedifficulties have been found in forming the loop. Because of its greaterpliability, there is no difficulty in forming a loop in a silk suturewhen cataract surgery is performed according to the abovedescribedprocedure.

It has now been found that the difiiculty in forming the loop whencatgut is used in cataract surgery may be overcome, and the advantagesof the ease of forming the loop when a silk suture is used may beretained by the use of a suture comprising a length of silk suturejoined to a length of catgut. This and other advantages of the inventionwill be apparent from the following description and accompanyingdrawings.

Referring to the drawings:

FIG. 1 shows a view of the suture of the invention with a surgicalneedle attached to the end of the silk portion.

FIG. 2 shows an enlarged fragmentary View of the suture of theinvention, and particularly the manner in which the silk and catgutportions are joined.

Referring to the figures, the suture generally indicated at 10 consistsof a gut portion 12, a silk portion 14, and a center portion 16, inwhich the silk and gut portions are joined by braiding means so that thesilk fibers making up the braided silk portion are braided around thegut. At the point 13 where the silk ends, it is desirable to apply asmall amount of adhesive such as an epoxy resin, in order that the silkfibers are prevented from brooming. It is preferred that a surgicalneedle 20 be attached to the end of the silk portion, and this may bedone in a conventional manner by clamping the end of the silk portion ina channel or a.hole drilled in the end of the needle. An eyed needle mayalso be used.

The manner in which the silk fibers 22, which make up the silk portion14, are braided around the gut portion 12, is illustrated in FIGURE 2.In the embodiment of the figures, the silk portion is composed of fourbraided silk fibers 22. The gut portion 12 forms a core about which thefour silk fibers of the silk portion are braided to form the portion 16at which the silk and gut portions are joined. The end 24 of the gutportion is covered by the four braided fibers of the silk portion.Although the embodiment of the drawing shows a silk portion having fourbraided fibers, more than four fibers may be used and satisfactorysutures have been made with six and eight fibers. The end 18 of the silkportion is, as pointed out above, treated with an adhesive so that thebrooming tendency is substantially reduced. Any adhesive may be used totreat the end of the silk portion which is not irritating to eye tissueand may be sterilized by any of the usual procedures used to sterilizesutures which do not substantially weaken or destroy the adhesive. Thepreferred adhesive to use is a thermosetting solution of an epoxy resin.A solution of epoxy resin and hardener containing approximately fiftypercent solids, which is sold by Rubber and Asbestos Corporation,Bloomfield, New Jersey, under the designation of Bondmaster M621, hasbeen used successfully.

The silk and gut portions are joined by introducing the gut into thebraid during the braiding operation at the point of braid formation. Asthe braiding progresses, the silk fibers are braided around the gut sothat the gut becomes a core for the braided silk fibers, as illustratedin FIGURE 2. It is preferred that the portion at which the silk and gutportions are joined be about one to three inches in length. Whenbraiding of the silk fibers around the gut core has progressed so thatthe braided portion is about one to three inches in length, the braidingmachine is stopped and the gut is positioned so that it will not enterinto the braid and form a core when the braiding operation is resumed.The braiding machine is then start ed and production of braided silk iscontinued until the silk portion is of the desired length. The machineis then stopped and a gut strand is again introduced into the PatentedApr. 28, 1 964 machine to repeat the cycle described above. Onecombination silk-catgut suture is produced by each cycle. Individualcombination silk-catgut sutures are obtained by cutting the silk portionof each cycle at the point Where the gut has been positioned so that itdoes not enter into braided silk fibers and form a core. It is preferredthat the silk portion of the suture be about siX inches in length, thegut portion about five inches in length, and the portion at which thesilk and gut is joined about one to three inches in length. In thepreferred form, the silk and gut portions of the suture of the inventionare size 6-0, 0.002 to 0.004 inch, and the portion at which the silk andgut are joined is not larger than size 4-0, 0.006 to 0.008 inch.

In using a suture comprising a length of silk joined to a length ofcatgut in cataract surgery, and particularly in cataract surgeryperformed according to the above-described procedure, a loop is formedin the silk portion after the silk portion is passed through theanterior and posterior lips of the groove in the sclera. Aftersectioning of the sclera has been completed and the cataract has beenextracted, the silk portion is pulled so that the remaining part of thesilk portion and the juncture of the silk and catgut are drawn throughthe sclera and only the catgut portion is in contact with the sclera.The catgut is then tied in a triple knot. The surgical procedure iscompleted in the usual manner by suturing the conjunctival flap backinto its original place.

While the invention has been described with some degree of particularityand reference to specific embodiments, it is nevertheless to beunderstood that the invention is not to be limited to any of theembodiments described but is to be restricted only by the scope of theappended claims.

What is claimed is:

1. A suture for cataract surgery comprising a portion of braided silksuture, a portion of catgut, and a portion between the silk and catgutportions at which the fibers of the braided silk suture are braidedaround the catgut which forms a core.

2. A suture according to claim 1 in which the ends of the fibers of thebraided silk suture are joined to the catgut core by an adhesive.

3. A suture according to claim 1 in which the ends of the fibers of thebraided silk suture are joined to the catgut core by an epoxy resin.

4. A suture according to claim 1 in which the ends of the fibers of thebraided silk suture are joined to the catgut core by an epoxy resin, thediameter of the silk and gut portions are about 0.002 to 0.004 inch, andthe diameter of the portion at which the silk and gut portions arejoined is about 0.006 to 0.008 inch and about one to three inches inlength.

5. A suture according to claim 1 in which the ends of the fibers of thebraided silk suture are joined to the catgut core by an epoxy resin, thediameter of the silk and gut portions are about 0.002 to 0.004 inch, andthe diameter of the portion at which the silk and gut portions arejoined is about 0.006 to 0.008 inch and about one to three inches inlength, and a surgical needle is attached to the end of the silk sutureportion.

References Cited in the file of this patent UNITED STATES PATENTS826,063 Reid July 17, 1906 1,180,386 Essbach Apr. 215, 1916 1,865,214Saladino et al June 28, 1932 2,387,320 Foster Oct. 23, 1945 2,591,063Goldberg Apr. 1, 1952

1. A SUTURE FOR CATARACT SURGERY COMPRISING A PORTION OF BRAIDED SILKSUTURE, A PORTION OF CATGUT, AND APORTION BETWEEN THE SOLK AND CATGUTPORTIONS AT WHICH THE FIBERS OF THE BRAIDED SILK SUTURE ARE BRAIDEDAROUND THE CATGUT WHICH FORMS A CORE.